In the past five years, every soldier who was killed in Iraq and Afghanistan has been given a CT scan. Why? In the hopes of creating a database of war injuries, which can be used to better equip and treat future soldiers.

The effort has already paid dividends. While examining the data, it was noticed that chest tubes used to treat pneumothoraces in the field were too short. The standard tubing would have been appropriate for 50 percent of soldiers, versus longer tubing that would fit 99 percent.

Also, it was because of these “autopsy scans” where it was noticed that many of the troops died from wounds in the upper torso, which could have been prevented with the appropriate body armor. On the basis of these findings, the military rushed more armor plates to Iraq.

It’s an interesting piece, and goes on to discuss the sensitive implications of the findings to family members:

The possibility that a relative burned to death is a particular source of anguish for families, and one area in which CT can outperform an autopsy. In a body damaged by flames, CT can help pathologists figure out whether the burns occurred before or after death. The scans can also tell whether a person found in water died from drowning.

It’s truly remarkable to see how much that can be learned after death.

In honor of National Nurses Week, the National Museum of Health and Medicine hosted a discussion about the history of nursing at Walter Reed. Debbie Cox, former Army Nurse Corps Historian, initiated the conversation by describing what nursing was like at the turn of the 20th century. Steam-driven ambulances transported patients out of “mosquito-infested” Washington, DC to fresh-aired Fort McNair. A leading controversy of the time involved the intention of the hospital administrators to place the nurse baracks near the horse stables rather than the main hospital. In a dramatic twist, Jane Delano (cousin of Franklin D. Roosevelt) saved the nurses from relegation to the stables. However, it wasn’t until 1920 that nurses were given rank by the army.

Entry into nursing was through the Red Cross exclusively until the first nursing school was opened at Walter Reed in 1918. From there, nurses grew in numbers and prestige, until they became a cornerstone of medical research in the 1950s, leading the way in understanding how to reduce the spread of infections in the OR, decubitus ulcers in the hospital wards, and radiation damage related to nuclear war.

Jennifer Easley, a nurse who works in the pediatric intensive care unit at Walter Reed, described her experiences as a nurse leader for a team of soldiers in Iraq. She derived great satisfaction as an officer in her unit, and said that the team spirit and camaraderie was unlike anything she experienced in civilian nursing. She had this to say:

“I only made it 18 months as a civilian nurse. When I was called back to serve in the army, I had my paperwork in so fast you could hardly blink. I found out that in the private sector, no one ‘has your back.’ There’s no protection for those who raise safety concerns and nurses don’t have the authority to request back up in cases where units are dangerously understaffed.

I remember one day when several nurses called in sick and there weren’t enough of us to cover the children and babies in the ICU safely. I reported this to my nurse supervisor and she told me that maybe I wasn’t cut out for a challenging work environment. I was shocked, and really feared for the patients.

Another problem with private sector nursing is that there are glass ceilings. If you apply for a job as a staff nurse, you can’t work your way up to nurse manager. You’d have to leave that hospital and apply for a nurse manager position elsewhere. In the army, I had many more opportunities to contribute, grow, and lead.”

The final speaker was a nurse who returned from Iraq with head and neck cancer. He (LTC Patrick Ahearne) was an inpatient at Walter Reed for many months, losing 35 pounds and experiencing severe nausea, vomiting, and depression. At his lowest point, when he had lost hope of recovery and wanted to die, he was met with kindness by an experienced nurse who knew how to ask the right questions and reframe his perspective:

“This wonderful nurse stayed with me for 2 hours, watching me vomit and talking me through it. I remember her asking me what I’d learned about myself through my illness. I thought it was a strange, and medically irrelevant question – but it was just what I needed at the time. I realized how strong the human body can be, and the inner strength I had to endure my cancer. In those two hours nurse McLaughlin took me from wanting to die to wanting to live. She taught me that it was ok to be angry. It was ok to be sick.”

Many thanks to the unsung heroes out there who touch lives like nurse McLaughlin. We couldn’t do it without you.

In yet another example of a fortuitous Twitter connection, Tim Clarke, Deputy Director of Communications for the National Museum of Health and Medicine reached out to me after I tweeted about Walter Reed. He graciously offered to give me a guided tour of the museum, located on the Walter Reed campus where I volunteer with the Red Cross.

We spent about an hour reviewing some fascinating exhibits, including the history of body identification techniques. If you’re a fan of NCIS, then you should run (not walk) to this museum to gain insight into the incredible evolution of forensic science over the past 150 years. The exhibit begins with Paul Revere’s dental tools (did you know he was a part-time dentist?) and the story of how he identified the body of a fallen soldier for whom he’d done some unique silver smith work.

The time of death and relative age of human remains can be gauged by bone erosion (they become smoother with age) and material evidence (the type of button found near the remains can be used to identify the season of death – larger buttons were used for heavy winter overcoats for example) among other things.

Did you know that finger print analysis is not automated? Apparently, to this day, a technician must be involved in the computer-generated comparisons because finger prints are too complex for 100% accuracy with computer models.

However, with the advent of DNA analysis, extraordinary advances have been made in our ability to identify remains. In one particularly fascinating case, Charles Scharf’s body was identified after his wife brought in a letter that he’d sent to her from Viet Nam in 1965. She had kept it in a plastic bag in a shoe box since that time. Charles had sealed the letter with his saliva, and because of the excellent condition of the envelope, tiny pieces of DNA remained in the glue. In 2006 pathologists were able to link his remains to his DNA sample, and finally confirm his fate.

Modern autopsies can be performed rapidly with the guidance of CT scanners. The likely internal injury that caused a soldiers death can be identified via CT, and then rapidly confirmed by pathologists. Research into armed forces injuries can result in improved equipment and increased safety. In one case, a retrospective analysis of CT scans demonstrated that military personnel had larger chest cavities (on average) than initially thought – this resulted in the provision of longer needles for chest tubes in trauma bays.

And speaking of trauma bays, the museum has transported an entire trauma tent from Balad Air Force Base in Iraq to memorialize medical care during the war. A 3000 pound concrete slab of flooring provides the base of the exhibit, complete with original blood and betadine stains, gouges in the plastic floor sealant, and duct tape. Original metal tent doors and canvas show evidence of sand storm damage, with sand still coating the tent air ducts. Action photos taken at the trauma bay surround the exhibit. Nothing brings home the reality of war like this living 3-D memorial.

Just to the left of the tent is a large photo of a Black Hawk helicopter and a wounded soldier being carried by EMS through a canvas archway. On the ceiling of the archway is an American flag. I turned to Tim and asked him why the flag was on the ceiling and he said,

“That was so the soldiers could look up from their stretchers as they arrived at the medical facility and know that they were ‘home.’ They were safe now, and were going to be taken care of.”

Tim also introduced me to the Abraham Lincoln exhibit, where the bullet that sealed his fate (along with skull fragments, a tuft of his hair, and his surgeon’s sleeves) are on display. It’s an extraordinary feeling, being so close to history.

I’m really glad that I had the chance to experience history with Tim, and I strongly recommend that you contact him to set up your own guided tour. If you’re a member of a professional society, or are coming to DC for a meeting or event, why not make the National Museum of Health and Medicine a part of your travel plans?

I volunteer at Walter Reed Army Medical Center (WRAMC) a half-day per week. I’m inspired by the soldiers in the occupational and physical therapy center, and am continually amazed by their abilities. The other day I watched a soldier with an artificial leg climb a rock wall better than I ever could, and marveled at a man who had both legs amputated above the knee – he was ambulating almost without a limp, and with the help of a straight cane alone.

As I watched these wounded warriors learning how to maximize their functional abilities – I overheard a staff member explain the reason why the Walter Reed hospital building is closing in 2011.

Apparently WRAMC is built on land owned by the District of Columbia. In an effort to subsidize the over-budget subway system, the city purposefully disallowed sufficient parking spaces to be built on the WRAMC site. The idea was to force staff to take the subway to WRAMC. The closest subway is a 20 minute walk from the hospital.

In addition to the limited parking, DC imposes a height restriction on all buildings in the district – they cannot be taller than the Washington monument. Therefore as Walter Reed grew and expanded, they could not add any floors to the hospital, but had to construct additional buildings on campus.

And so, in about three years time, Walter Reed will shut down, moving their remaining staff to the Navy hospital in Bethesda, Maryland where there is plenty of parking and no building height restrictions.

I’m not sure what the total cost of moving the army hospital to the navy center will be, but I’m guessing in the hundreds of millions. How much did the staff complaints about not wanting to walk to work play into all of this? I don’t know, but I’ve seen them drive in as early as 5:30 am to get one of the few parking spots. This attitude is consistent with Americans’ general unwillingness to adopt an active lifestyle, and it’s costing us all so much more than we realize.

It’s possible that laziness dealt the final blow to Walter Reed: a facility created to get people active again after war injuries.

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